Article: Foot deformity and the length of the triceps surae in Danish children between 3 and 17 years old.
Reimers, Jørgen, Bente Pedersen, and Anne Brodersen. "Foot deformity and the length of the triceps surae in Danish children between 3 and 17 years old." Journal of Pediatric Orthopaedics B 4.1 (1995): 71-73.
- 769 children between 3 and 17 years old were examined to evaluate ankle joint dorsiflexion using the proper technique of subtalar neutral with locking of the midtarsal joint measured with a goniometer
- 1,520 of the 1,538 feet had carbon foot prints done
- No significance in ankle joint dorsiflexion between sexes
- With increasing age the number of patients that could only reach 90° increased from 24% to 64%
- In the older groups (median age of 16 y/o) 13% failed to reach the standard definition for equinus of +5° ankle joint dorsiflexion with knee extended
- High arch feet were documented to increase from the younger age group (mean age of 3.7 y/o) to the older age group (median age group of 16 y/o) from 2% to 7%
- Flat arch feet were documented to decrease from the younger age group (mean age of 3.7 y/o) to the older age group (mean age group of 16 y/o) from 42% to 6%
- In the youngest group (median age range 2.11 to 5.1 y/o) there was no statistical significance between the high arch, normal and low arch feet in regards to equinus deformity presence
- In the oldest group (median age range 11.8 to 17 y/o) the flat arch group had a significantly higher rate of equinus with the oldest group of children with flat feet having a 100% rate of equinus
- In the oldest group described above, the high arch feet group had a lower rate of equinus than the normal arch feet group
- “A short tendo Achilles may also be one of the reasons why some feet do not correct spontaneously with growth.”
DeHeer’s Opinion: This article confirms some very interesting information. Kids with flat feet have equinus, which is theoretically why these pediatric flatfeet do not resolve with age. Additionally, as other authors have stated the pediatric arch does not fully develop until approximately age 4 years. Infants and toddlers have flat, fat, and flexible feet that develop into a stable arch with time, as the study showed a decrease in flat arch feet in the younger group from 42% to 6%. Kids with pathological flat feet will have equinus as shown by this study of the older group of flat feet kids with 100% equinus rate. It is crucially in treating these children, whether surgically or conservatively, the equinus deformity must be treated as well. Without treating equinus in pediatric flatfeet, the results are doomed to failure as this study and others have demonstrated. An interesting side note is the lack of equinus associated with the high arch feet group. Equinus is not associated with cavus deformity and is termed pseudo equinus (lack of ankle joint dorsiflexion due to the ankle dorsiflexing to bring the forefoot and rearfoot parallel with each other in the sagittal plane). When I treat a pathological pediatric flatfoot case conservatively, I stretch the child to correct the equinus deformity then follow with custom orthoses to treat the flatfoot. The outcomes are significantly better with this methodology.